MINDS ON FILM

Introduction

Manchester by the Sea is written and directed by
Kenneth Lonergan. It was released in the UK in 2016 and has since
won 115 awards. These include two Academy Awards in 2017 for best
performance by an actor in a leading role (Casey Affleck, who is
outstanding as Lee Chandler) and best original screenplay; a Golden
Globe in 2017 for best performance by an actor and two BAFTAs in
2017 for best leading actor and best screenplay to name only a few
of them. The film provides a harrowing but compelling account of a
family’s tragedy over many years and it explores the tensions that
can exist between individual need and the expectation that family
ties may bring.

The Film

The story centers on Lee Chandler, a troubled,
socially isolated, man who is working in Boston as a janitor when
the film opens. He is unexpectedly summoned back to his hometown of
Manchester-by-the-Sea when his brother Joe dies suddenly. Lee finds
himself staying in his brother’s home and being responsible for his
brother’s son Patrick, who is 16 and still at school. Some of these
scenes provide the lighter interludes to the film and also contrast
Patrick’s less complicated experience of grief with that of his
uncle. The family’s back-story is fleshed out using flashbacks
throughout the film. These show glimpses of the playful
relationship that Lee had with his young nephew some years before
as well as showing how his brother Joe had been a strong and
supportive presence for Lee through the toughest of times that led
to the breakdown of Lee’s marriage. In these scenes, we learn that
Joe too was divorced from his wife and that she had a serious
problem with alcohol. I have chosen not to give further details of
the tragic events suffered by Lee, as the build up to their
revelation is intrinsic to the emotional power of the film, except
to state that he was only able to cope with them by moving away
alone to live and work in Boston.

As the story of his earlier family life continues, the account
of his struggle to care for Patrick unfolds in parallel and Lee
embraces the parenting as best he can. Although he appears to make
some progress in his role as a carer, Lee cannot seem to overcome a
fundamental resistance within himself that prevents him from
considering the possibility of resettling in Manchester-by-the-Sea,
the location of his past traumas. However, despite this drive to
flee, Lee’s internal conflict about the choice he must eventually
make concerning Patrick is almost palpable as the film reaches its
conclusion.

Relevance to the Field of Mental Health

Manchester by the Sea provides a powerful portrait of
grief, but additionally adds the complication of both recent and
past losses suffered by the main protagonist, Lee. This makes the
film especially useful for mental health professionals wanting to
teach or learn about prolonged grief disorder (as defined in
ICD-10) or persistent complex bereavement disorder (as defined in
DSM-5). In May 2017, the BMJ published an infographic on the
subject of abnormal grief in the Practice Pointer section
of the journal, which accompanied the article entitled Disturbed
grief: prolonged grief disorder and persistent complex bereavement
disorder by Paul A Boelen & Geert E Smid (BMJ 2017; 357 doi:
https://doi.org/10.1136/bmj.j2016).
This would be a very valuable resource to use alongside a viewing
of the film when thinking about Lee’s presentation. Also available
on the linked webpage is a podcast about helping patients with
complex grief, featuring an interview with the authors of the
article.

Spending time immersed in this film will undoubtedly provide an
empathic experience of the numbness, hopelessness, rage and despair
that accompany the main protagonist as he struggles to find a way
through the tragic losses he has suffered whilst at the same time
trying to deal with the expectations placed upon him by his dead
brother. This makes the film immensely valuable to any health
professional that might encounter patients suffering with abnormal
grief in the course of their work and I cannot recommend it more
highly.

More information about Manchester by the Sea can be
found at IMDB,
as can a short trailer.

Manchester by the Sea is available on DVD and to stream
at amazon.co.uk.

Introduction

Lilting is the first full length film written and
directed by the Cambodian born British director Hong Khaou. It was
released in the UK in 2014. It is a study of grief that brings
together Richard and Junn, respectively the British lover and
Chinese Cambodian mother of Kai, a young man killed suddenly in an
accident. Despite both living in London, Richard and Junn do not
share a common language to communicate the complexity of their
feelings and emotions as Junn has never learnt to speak English.
She is also unaware of her son’s gay relationship. Beautifully
filmed and with exquisite performances by Ben Wishaw as Richard and
Pei-Pei Cheng as Junn this is a deeply powerful examination of the
role that language and culture play in our ability to understand
others, especially in the context of grief.

The film was nominated for a BAFTA film award in 2015 and won a
Cinematography award at the Sundance Film Festival in 2014.

The Film

Lilting opens with Kai visiting Junn in the room of her
residential care home. It quickly becomes clear that this is a
flashback. Junn seems sad and lost. When Richard visits Junn in the
residential home they struggle to connect without a common language
but Richard is confronted by her indifference towards him. Richard
learns that Junn has a ‘suitor’ in the form of Alan, another
resident at the home, who gives Junn flowers every day despite
having no ability to talk with her. As Richard is determined to see
more of Junn, he arranges to pay a female friend Vann, who speaks
various Chinese dialects, to translate for him and they visit the
residential care home together. Initially, Richard introduces Vann
as someone who can assist Junn and Alan with communication, but the
opportunities also emerge for Junn and Richard to discuss Kai. Junn
has no understanding of the relationship her son had with Richard
and several flashbacks reveal that Kai had arranged for his mother
to move into the residential home because he could not have her in
his home without her knowing about his homosexuality. Crucially,
the flashbacks also reveal that Kai had planned to come out to his
mother just before he died.

Richard has the need to share his grief with the one other
person closest to Kai but knows that he can’t do this until she
understands the true nature of his intimate relationship with Kai.
As part of his own grieving process Richard seeks closeness with
Junn and perseveres in visiting her until he feels able to invite
her back to the home he and Kai shared where he can give her Kai’s
belongings. Before the truth is revealed, Richard is drained by
having to stifle the outward expression of his most painful
sadness. The final scene that takes place in Richard’s home brings
the long awaited revelation by Richard that he and Kai were in a
gay relationship and that Kai had been ready to tell her this just
before he died. By this time, Junn and Richard seem to have forged
a more positive bond.

Relevance to the Field of Mental Health

Lilting is a subtle and gentle film that immerses the
viewer in the lives of the two main protagonists and of their
emotions as they struggle to process the sudden loss of the person
that was closest to them. As such, it highlights that grieving is a
uniquely personal process governed by so many factors and not
restricted to any distinct time period and that is almost
universally assisted by a need to share sadness and memories of the
lost one. Funerals are a ritualised way of bringing people together
to do just such a collective remembering whilst also acting as a
celebration of life. Secrets and hidden relationships inevitably
get in the way of any shared grieving. In Lilting this is
perfectly illustrated by the painful realisation Richard has that
he must ultimately comply with Junn’s wishes to have Kai’s ashes
before she knows the true nature of her son’s relationship with
Richard.

The issue of language is always centre stage in
Lilting, something that is so relevant in our current
multi-cultural society in which understanding others may be made
more challenging by any language barriers. The observations
presented about the use of translators in the scenes with Vann are
particularly pertinent when Richard says something and immediately
asks that it not be translated, realising just in time that it’s
the wrong message to give. However, Vann also shows that there are
hazards to translating emotionally charged messages when she cannot
help herself from saying something to Junn that was not requested
and causing upset to her as a result. In addition to this, the film
demonstrates how much we can communicate non-verbally when someone
is speaking a language that we do not understand. Deliberate
choices are made during certain scenes of the film that leave the
viewer without a translation into English for what is being said by
Junn and yet still offering a strong sense of what she is feeling.
In this way the film gives very useful tuition on what it is like
to conduct an interview through a translator.

The relationship between Alan and Junn in the residential home
offers the opportunity to reflect on the nature of intimacy when
there is a fundamental lack of knowledge available about a person’s
background, culture, values and experiences and when these cannot
be explored through common language in an ongoing way. The physical
comfort that both gain from holding hands, hugging, dancing and
kissing clearly meets a deep need for both elders but is it
possible for a more intimate bond to develop beyond this? This
question is answered when Vann the translator offers Alan and Junn
the chance to talk and question each other more honestly, bringing
a reality to their relationship that had previously not been
possible. Once they know each other better, it is Junn who decides
to end the liaison.

These issues of communication and language are key to the work
mental health professionals must do and this film provides an
excellent reminder of just how hard it can be to understand another
person when we do not share our first language and must rely on
translation by an intermediary.

I would highly recommend this film.

More information about Lilting, can be found at IMDB,
as can a short trailer.

Unusual family experiences

Vascular Dementia

Life, Animatedis a
documentary film released in 2016, directed by Roger Ross Williams,
based on a book of the same name written by Ron Suskind. In it
Suskind tells the story of his son Owen, who was diagnosed with
autism at the age of three and who discovered a passion for
Disney’s animated films, which later provided him with a means to
communicate with his family and to make sense of his emotions more
effectively. As the director is quoted as saying in an
Oscar-contender interview atindiewire.com,
“It’s really a film about the power of actual story, Owen is
someone who was raised on myth and fable”.

The film is nominated for Best Documentary
Feature in the 2017 Academy Awards and has already won eleven other
awards.

The Film

Life, Animated opens with some home
video footage of Owen, a chatty young toddler, play-fighting with
his father Ron in their yard. He has an older brother Walt with
whom he enjoys watching television. But everything changes as Owen
approaches his third birthday and suddenly becomes mute and
inconsolable, resulting in a diagnosis of autism. The family
observes that Owen still finds comfort in the animated films he had
previously enjoyed and can continue to share this activity with his
sibling. When his parents make the incredible discovery that they
can communicate directly with Owen if they become a character in
one of his Disney films they start using the scripts to engage with
him in conversation. This is precisely how their son first begins
to talk again after more than a year of silence. As Owen learns all
of the scripts from each film by heart it becomes clear that he is
using the films to communicate and express his feelings and
emotions. Once at school, it emerges that Owen is especially
identified with the supporting characters in many of the films and
he becomes one with these ‘Sidekicks’. Owen has a talent for
drawing and skilfully reproduces the characters he loves on paper
and he learns to read and write using the credits at the end of
each film. His identification with the ‘Sidekicks’ is helpful when
he is forced to deal with being bullied at school. The film uses
some exquisite animated scenes uniquely created to supplement the
account of Owen’s earlier experiences, including with his
‘Sidekicks’, and these animations grow in complexity from black and
white drawings to full colour as they depict his own emotional
development. Life, Animated also contains numerous clips
from the relevant Disney films that are so important to Owen in
negotiating major challenges and transitions in his life. This is
most poignantly illustrated by his watching of Dumbo as he
packs up his things to move out of the family home after his
graduation and then the viewing of Bambi (the scene in
which Bambi’s mother dies) after his parents leave him in his flat
for the first night.

Life, Animated includes clips from
home video to show excerpts from Owen’s life at all stages through
his childhood into young adulthood but these are continually
interspersed with filming of his current life. These contemporary
scenes build through his final session of the Disney club he
founded at his high school, his graduation, some therapy sessions
to prepare him for his move into his own accommodation, the actual
relocation and once there his experience of breaking up with his
girlfriend of several years, Emily. This breakup presents Owen with
a huge emotional challenge and the film depicts his struggle with
anxiety and loss very honestly. The viewer is left with no doubt as
to the challenges ahead for him, whilst at the same time the film
details Owen’s transformation into an ambassador for autism
exemplified by an invite to speak at a conference in Paris. Here he
shares his passion for Disney films and his family’s use of them in
helping him to escape from a state of mutism to a place where he
can communicate effectively enough to obtain work in his local
cinema complex. This makes a fitting conclusion to the
film.

Relevance to the Field of Mental
Health

Life, Animated is a documentary film
that highlights the therapeutic power of the creative arts. The
Suskind family’s story helps to underline the positive benefits
they found in sharing in the affinity or passion of their autistic
son in order to open up a medium for communication that allowed
them to connect with him socially. The exaggerated expressions on
the faces of the characters in animated films encouraged him to
learn about the emotions and feelings of both himself and others
and the scripts gave him a means of saying what he felt. It is hard
not to be moved by watching Owen engrossed in the scene in which
Bambi painfully calls out for his lost mother just after his
parents have delivered him to his first night alone in his
supported living accommodation.

This is a very positive film to watch but it
also doesn’t shy away from capturing something of the exhaustion
that Owen’s parents experience as they must join him endlessly in
his Disney world in order to communicate with him, or of his
brother’s sense of responsibility as he wonders what the future
holds once he is solely responsible for Owen’s wellbeing. It
certainly demonstrates the powerful and positive effect that strong
family bonds, with a huge capacity for love, kindness and endless
tolerance, provide for someone like Owen suffering from
autism.

Ron Suskind has written an interesting
account of his experiences in a New York Times article titled
‘Reaching my autistic son through Disney’, published in March 2014
and Ron and his wife Cornelia have created an informative website
also calledLife,
Animated, in which they offer
insights into the techniques that they have found beneficial during
their parenting of Owen. There is a particular focus on the
passions, which they call Affinities that those with Autism
Spectrum Disorders often have. There are some personal resources
based on their experiences with Owen and the website also includes
input from the psychologist Dr Dan Griffiths, who supported the
Suskinds in developing the concept of ‘Affinity
therapy’.

Life, Animated provides a
beautifully crafted individual case study of autism that gives
important insight into what it is like living with the disorder
and, if viewed alongside a visit toThe National Autistic
Societywebsite, it would provide an excellent
learning experience that follows on perfectly from my last blog on
Asperger syndrome in considering the Autism Spectrum
Disorders.

More information about Life,
Animated can be found atIMDB,
as can a short trailer.

Asperger’s Are Us is described as a
coming of age documentary and is the directorial debut of Alex
Lehmann. It is an inspiring and entertaining film about four
friends diagnosed with Asperger syndrome, which means that they are
on the high-functioning
end of the autism spectrum. The quartet, formed of Noah Britton,
MichaelIngemi, EthanFinlanand JackHanke, first met a decade earlier at a
summer camp for teenagers with Asperger’s where their close
friendship coalesced around their mentor Noah, who was older and
working at the camp to support others with his condition. The four
found a shared interest inhumourand performing and out of this arose
the comedy show that shares the title of the film. This documentary
follows them as they prepare to stage their last public show
before their young adult lives take them in different directions.
Netflix acquired the worldwide rights to screen Asperger’s Are
Us in March 2016.

The Film

Asperger’s Are Us begins by
introducing us to the four friends, providing some background on
each man in turn, and highlighting their individual
characteristics. The young man who perhaps features most in the
film calls himself New Michael (he calls his father Old Michael)
rather than his given name of Aaron. The film gives a sense of the
struggles that New Michael’s parents have had throughout his
childhood and adolescence as they are interviewed several times.
Noah, the oldest man of the troupe and originally mentor to the
others, is very engaging as he provides a somewhat droll commentary
and continues to be the apparent motivator for the group. Jack is
introduced within his family home as he contemplates leaving home
in the USA to go to Oxford University in the UK, where he has been
awarded a prestigious scholarship for a year. His family outline
that Jack doesn’t like to be touched and Jack appears slightly lost
as his father attempts to ruffle his hair playfully. Lastly, the
quietest member of the quartet is Ethan who admits to having a
pronounced interest in trains.

The film is structured as a timeline that
records the troupe’s progress as they prepare for the final theatre
performance of their comedy show. The hazard of rehearsing with a condition that
impairs focus is well portrayed and yet their commitment to their
material is very apparent. Thehumourtends tofavourword play and is often dry, deadpan
and absurd. Very little of the actual show features, but there is
enough to demonstrate the nature of theirhumourand how it relates to their unique
relationship with the world. The film even captures some members of
the audience walking out during the show, demonstrating that
thehumourisn’t to everyone’s taste.
However, the powerful bond that the four friends share is palpable
and this is touchingly displayed in the film. It also has a
particularly satisfying conclusion by providing a brief
summary of how the men’s lives have developed more than a year
after this final performance together.

Relevance to the Field of Mental
Health

This is a feel good film about friendship
and the therapeutic power of creativity in four young men who have
been diagnosed with Asperger’s. It is especially interesting that
they have found a social connection throughhumourand the collective purpose of
performance. As those on the autistic spectrum, including with
Asperger syndrome, characteristically struggle to use or
understand facial expressions, tone of voice, abstract concepts and
jokes and sarcasm, the development of a comedy routine becomes all
the more impressive and interesting.

The film provides an excellent educational
resource for broadening understanding about Asperger syndrome and
viewing it could usefully be combined with browsing the following
resources. The website of TheNational Autistic
Societyhas some very helpful information on
Asperger syndrome and a very good short video titled ‘What is
autism’. There is also a usefulfactsheet at
the Royal College of Psychiatristswebsite with information for parents
andcarersabout Autism and Asperger
syndrome.

Most of all, I recommend this film for its
ability to portray its subjects without pity or negativity about
their disability despite showing some of the challenges that they
face. It seems that this is just what the four friends would wish.
They are quoted as saying that their show is not an autism
awareness campaign but a pure comedy act designed to entertain.
What a fun way to start the year!

More information about Asperger’s
Are Us, can be found atIMDB,
as can a short trailer.

Asperger’s Are Us, is
available to stream from Netflix and fromAmazon
video.

This animation contains adult themes of a sexual nature
and nudity. It is rated 15.

Introduction

Anomalisa is a
feature-length stop-motion animation film directed by Charlie
Kaufman and Duke Johnson, its screenplay written by Kaufman and
based on an earlier radio play that he wrote in 2005. It has been
very well received by critics, was nominated for an Academy Award
in 2016 and has received 20 awards. Stop motion is a painstaking
technique of animation, which involves taking approximately 25
photographs per second of a puppet or scene as minute changes are
made to them (an article written by
Tim Martin in The Telegraph newspaper, in March 2016, provides
a good understanding of this method of animation as he considers
Kaufman and Johnson’s production).

Anomalisa is a psychological drama centred on the main
protagonist Michael Stone (voiced by David Thewlis), an author and
motivational speaker in the field of customer service. He is
suffering from mid-life depression and is searching for a special
person that will make him happy as he struggles with a sense of
boredom and a feeling that everyone is the same. The feeling of
‘sameness’ is represented in the film by all of the characters,
except for that of Michael and Lisa (who is voiced by Jennifer
Jason Leigh), being voiced by the same male actor (Tom Noonan). In
addition, all of the puppet faces have the same central features,
except for those of Michael and Lisa.

The Film

The soundtrack that
accompanies Anomalisa’s opening credits presents us with a
cacophony of voices of increasing intensity. We see Michael on an
airplane travelling to Cincinnati. He takes some prescribed
medication just before landing and also looks at an angry letter
from a former girlfriend. As he walks through the airport terminal,
Michael blocks out the voices around him by listening to some
calming music through headphones. The viewer might observe the
similarity of the faces that surround Michael. Once Michael is in a
taxi driving to The Fregoli hotel, the attentive viewer may become
aware that the driver also has the same face and voice as the
people chattering in the airport terminal. The taxi driver spots
that Michael has a British accent, asks where he is from, and urges
him to visit the local zoo. Michael informs him that he actually
lives in Los Angeles and then asks if there is a toy store near to
his hotel. Once in his hotel room, Michael makes a phone call home
to his wife Donna and their son Henry. The lack of emotional
connection with his family is palpable. He tries to rehearse his
presentation for the following day but his thoughts soon turn once
again to his former girlfriend Bella, still living in Cincinnati.
He calls her, wanting to apologise for the way in which he abruptly
ended their relationship many years before, and tells her that he
misses her. He asks her to meet him in the bar of the hotel. He
tells Bella that he thinks he has psychological problems and she
comments on his drinking habit. Michael suggests that they go
upstairs to his room, which shocks and angers Bella prompting her
to leave the bar immediately. Gaining no satisfaction from the
meeting, Michael seems sadder and more alone than ever.

He goes out to the suggested toyshop in search of a gift for his
son, but discovers that the taxi driver has actually sent him to a
sex shop. Here he finds an antique Japanese doll, a sex toy, which
he buys despite it being so obviously inappropriate as a gift. Back
in his room and after a shower he has a strange perceptual
experience while looking at his face in the bathroom mirror and at
the same time hears the voice of someone else nearby which
frightens him. He runs out of his room knocking on doors nearby. It
is then that he meets two women Emily and Lisa, who are booked to
see him speak at the customer services conference the following
day. Michael invites them to have drinks in the bar and he becomes
instantly attracted to Lisa, in part because of her lovely voice
(which is distinct because it is actually voiced by a female
actor). Lisa has had past trauma and is marked by a scar on her
face. Michael invites her back to his room and seduces her by
trying to counter her lack of self-esteem related to her disfigured
face and her feelings of alienation. She sees herself as different,
an anomaly, and Michael creates a name for her and the film in
Anomalisa. He feels that Lisa is ‘the special one’ for him, the
person who might release him from his entrapped and boring life.
After having sex they go to bed and sleep. Michael has a torrid
nightmare in which he experiences fear and paranoia and expresses
the belief that everyone is the same one person, except for him and
Lisa. Once awake and during their breakfast the next morning he
hears Lisa’s voice differently, overlaid by the same male voice of
all of the other characters, reprising the taxi driver’s
recommendation to visit the local zoo. At this point he begins to
feel different and suspicious about her. Michael accuses her of
being controlling and seems to become more agitated, even as he
discusses plans to leave his wife for her. He is so distressed that
he finds himself unable to perform at the conference presentation a
little later. The film ends with him returning home to his wife and
son and asking her "who are you Donna, who are you really?"

Relevance to the Field of Mental Health

This is a film about
mid-life depression, which also hints at a rare delusional disorder
called the Fregoli
syndrome, in which the person believes that everyone is
actually the same person in disguise. It is classed as one of the
Delusional Misidentification Syndromes (DMS) and the signs and
symptoms usually occur in the context of other disorders, most
commonly schizophrenia, affective disorders, substance misuse,
organic brain disorders and traumatic brain injury. More recent
studies using neuroimaging suggest that these DMS may be associated
with identifiable lesions in the right frontoparietal and adjacent
regions of the brain.

In the extra features on the
DVD, Kaufman acknowledges that his interest in the Fregoli syndrome
was sparked by reading an article about the condition, which
inspired him to incorporate the concept into his script although he
denies that Michael’s character actually suffers from the syndrome
(more about this is outlined in an article written by Julia
Llewellyn Smith in
The Telegraph newspaper in March 2016).

Anomalisa is an
intriguing animation, which powerfully conveys emotion and
psychological crisis through its puppets in a most remarkable way,
including a sensitively portrayed scene of sexual encounter. At
times the film leaves the viewer unsure of what they are seeing and
perhaps lacking trust in knowing what is real and what is not real
in the protagonist’s world. This filmic experience might open up a
window on the world of someone suffering from abnormal perceptions
and in particular of the bizarre Fregoli delusion. The film will
sharpen the viewer’s powers of observation and I cannot recommend
it more highly, especially as it invites any mental health
professionals to consider a more unusual and challenging diagnostic
formulation in the context of Michael’s mid-life depression.

More information about Anomalisa can be found at
IMDB, as can a
short trailer.

Concussion, written and directed by Peter
Landesman, was released in the USA in 2015. The film tells the true
story of how Chronic Traumatic Encephalopathy (CTE) was
identified and named in 2002 by forensic neuropathologist, Dr
Bennet Omalu (played by Will Smith), while he was working in
Pittsburgh, USA. Omalu identified CTE as an entity after studying
the deaths of several retired American football players. He
realised that these former players had suffered significant
psychiatric morbidity in the years after their retirement from the
game. This discovery has contributed to a greater understanding of
the long-term effects of repeated concussions in those competing in
contact sports and has influenced attitudes to the management of
concussive episodes on the field in a wider number of sports such
as rugby, ice hockey and horse racing as well as in American
football. There has also been a particular focus on the management
of concussion in school age children, with more stringent pitch
side assessments that prevent participants from re-entering a game
until they are assessed as having fully recovered from a concussion
under supervision.

As well as telling the story of his scientific discovery, the film
also depicts the enormous struggle that Omalu, an immigrant from
Nigeria, and his few supporters faced when trying to report their
findings to the scientific community and the wider world of sport,
as his results appeared to threaten the corporate interests of the
National Football League (NFL). As such, Concussion is a
film about whistleblowing and Omalu has been likened to ‘David’ as
he took on the NFL seen as ‘Goliath’. Although this aspect of the
film is presented in the style of a classic Hollywood drama, the
film still succeeds in raising the profile of an important and
ongoing issue, namely how hard it may be to tell truth to
power.

The film has been nominated for several awards, including a Golden
Globe nod in 2016 for Will Smith.

The Film

Concussion opens with the death of former
American football player Pittsburgh Steelers centre Mike Webster at
the age of 50. His postmortem is carried out by Omalu in his very
particular style of working. Webster's pre-morbid psychiatric
difficulties are noted by Omalu and when another retired player
presents with psychiatric problems before his early death too, the
pathologist starts to look for a common neuropathology.

As Omalu suggests a connection between the repeated
head traumas suffered in the course of playing American football
and the microscopic findings post mortem, he begins to find his
work obstructed and colleagues turning against him. When he loses
his research funding he is so determined to continue that he uses
his own monies. It is only when a former football team doctor joins
him and supports his research that he is able to take his findings
forward and present them to the wider scientific community. Omalu’s
resilience and determination are admirable but his ultimate
satisfaction does not occur without a test of his character and of
his close personal relationships.

Relevance to the Field of Mental
Health

Concussion in sport is now increasingly recognised
as something that needs more research, particularly into its
long-term effects. The International Concussion and Head Injury
Research Foundation, (ICHIRF) is a London based
not-for-profit organisation that has been created to carry out
independent research into concussion and head injury. In its
research project Concussion in Sport it aims to ascertain whether
there is an increased incidence of neuro-degenerative disorders
(such as Alzheimer’s disease, Parkinson’s disease and Chronic
Traumatic Encephalopathy) in retired sportsmen and sportswomen who
have competed in contact sports and sustained concussions, and
whether these disorders might onset at an earlier age in this
population. The study is currently recruiting both retired athletes
and controls and it involves an online questionnaire (this takes
about 15 minutes) every year for at least the next 4 years.This
research foundation works closely with the charity called The Concussion Legacy
Foundation in America, whose website has a
wealth of material for learning more about the subject and in
particular some very good information about CTE.

Earlier this year the NFL finally acknowledged a
link between playing American football and CTE (read this Frontline
article written by Jason Breslow in March 2016) following the
research findings of Boston based neuropathologist, Dr Ann McKee.
In her research, McKee found evidence of CTE in 90 out of 94 brains
she examined postmortem of former NFL players. In a fascinating 46
minute Frontline video
interview, she describes her work and her
consultations with the NFL about the effects of repeated mild brain
trauma that takes place during the course of a football game. She
recounts how she had first encountered Omalu’s evidence in a poster
presentation at an Alzheimer’s disease conference and later how she
was asked if she would examine the brain of a football player by
the co-founder of The Concussion Legacy Foundation, former wrestler
Chris Nowinski. The evidence is now so strong that current players
are much more aware of the risks that playing presents and last
year Chris Borland, a promising player for the San Francisco 49ers,
quit at the age of 24 after fearing for the effects of repeat
concussions on his health (see BBC report).

For anyone involved in providing medical support to
players during competitive contact sports, there is a useful
Pocket
Concussion Recognition Tool on the BMJ website taken
from the Concussion Statement on Concussion in Sport,
published in the British Journal of Sports Medicine 47 (5), 2013,
by McCrory at al, which provides clear guidance on screening anyone
who is suspected of having suffered a concussion.

This film highlights a topical and very important
issue that is especially relevant to anyone working in the field of
Acquired Brain Injury or Sports Medicine.

• More information about Concussion can be
found at IMDB, as can a short
trailer.

•Concussion is available on DVD at
amazon.co.uk or for streaming on Amazon
video.

• Minds on Film is written by Consultant
Psychiatrist, Dr Joyce Almeida

Introduction

My Beautiful Broken Brain is a
documentary directed by Sophie Robinson and Lotje Sodderland, which
was released for streaming on Netflix in March 2016. The film
chronicles the experiences of the then 34 year-old filmmaker, Lotje
Sodderland, after she suffered a haemorrhagic stroke affecting her
parietal and temporal lobes in November 2011. This was later found
to have been caused by a malformation of blood vessels present from
birth. She was left initially unable to speak, read and write or to
sequence thoughts and actions in a coherent way. The stroke also
left Sodderland with a profoundly altered self-awareness and
perceptual disturbances that included the exaggeration of sounds
and seeing heightened colours in her right visual field, which was
also significantly restricted. These visual impairments are
brilliantly portrayed using special effects in many ‘point of view’
shots throughout the film. My Beautiful Broken Brain came
about at the instigation of Sodderland who, in the first two weeks
after waking from an induced coma in intensive care, grasped that
she was a filmmaker and realised that she could use the medium to
record valuable memories of her daily life.

There is a very good article written by Sodderland about her
experiences and the making of the film published in The Guardian Weekend Magazine in 2014. My
Beautiful Broken Brain is so valuable to clinicians because it
is underpinned by the authority of the lived experience of the
filmmaker, showing us what it actually felt like to her as she
suffered her acquired brain injury as well as charting the many
challenges of her neuro-rehabilitation.

The Film

My Beautiful Broken Brain begins with a narrated
account by Sodderland of her stroke accompanied by images that
express the feelings she had retrospectively of those moments.
Woken in bed one night with an excruciating headache, knowing that
something was seriously wrong, she somehow managed to get out of
her flat in East London and into a nearby hotel where staff
subsequently found her collapsed in the toilet. The filming begins
within two weeks of her stroke, using her own iPhone and then
proceeds over the next year with the help of director Sophie
Robinson with whom Sodderland had collaborated in the past.
Sodderland sees the film as a means of making sense of her story by
recording a linear narrative that she could review as and when she
needed it. Her brother, Jan, and other friends provide an
understanding of the person Sodderland was before her stroke,
namely bright, energetic, articulate, very sociable and extremely
good at multi-tasking. She was a passionate reader and an expert
communicator. The film depicts the total assault that has occurred
on all of these aspects of her person that render her so bereft in
the immediate weeks after the stroke. Sodderland describes her
predicament fearfully “I can’t write at all or be clever at
all…..it’s terrifying”. She also experienced an altered sense of
time, noting that “Time is elongated and transient” and she felt
sufficiently strange to compare the experience to living in a
David Lynch movie.
As a result, Sodderland recorded and sent a series of video
messages to the famous director, which ultimately resulted in Lynch
becoming an executive producer on the film and meeting up with
Sodderland in person.

The documentary moves through the first year after Sodderland’s
stroke chronologically, using much footage from her personal iPhone
videos as well as special visual effects, to record her progress,
including a three month admission to a Neuro-Rehabilitation ward,
enrolment in a research study using
transcranial direct current stimulation to aid post stroke
recovery, the set back of a grand mal seizure and, later on, to
Sodderland’s first foreign holiday in France. At all times the film
offers us insight into how she is feeling about her altered place
in the world through the interface of her ‘new brain’ as well as
through the objective opinions of those closest to her.

Relevance to the Field of Mental Health

My Beautiful Broken Brain is an incredibly compelling
film to watch. Most useful to all health professionals is its first
person portrait of the post stroke period of recovery. It should be
essential viewing for anyone working in the field of Acquired Brain
Injury. Of particular interest is the understanding, brought by
various professionals during Sodderland’s rehabilitation, of her
cognitive deficits and how these are worked on. My Beautiful
Broken Brain gives the viewer the chance to observe closely
someone struggling with nominal aphasia, emotional lability, the
inability to write meaningful words on a page, and also with the
strangeness of being able to touch type again, but not to be able
to read the words that have just been typed.

It is well recognised that there is an increased risk of
seizures in the year following such a haemorrhagic stroke but
Sodderland’s grand mal fit may also have been triggered by the
transcranial direct current stimulation administered to her as part
of the research study she joined (the study subsequently excluded
people in the first year after a stroke). There is an article
entitled Review of Transcranial Direct Current Stimulation in
Poststroke Rehabilitation written by Feng, Bowden & Kautz
in the journal called Topics in Stroke Rehabilitation, in
2013 Jan-Feb;20(1):68-77 (abstract
available) that offers the opportunity for further discussion and
learning on these topics.

As a personal video diary that conveys an intimate portrait of
recovery after stroke, My Beautiful Broken Brain exceeds
expectations because most of all it is a film filled with hope,
courage and the acceptance of a new and altered life that was not
chosen by Sodderland but that is now her reality. This is a perfect
reminder that it is always the whole person that we must understand
and engage with whenever we support someone in his or her recovery.
I could not recommend this film more highly.

More information about My Beautiful Broken Brain can
be found at the film’s website, as can a
short trailer.

Introduction

The Wolfpack, directed by Crystal Moselle,
was released in 2015. It is a documentary film that charts the
lives of the six Angulo brothers who grew up with their mother and
sister largely confined to their New York apartment by their
father. One brother describes their father “as a land owner and we
are the people working on the land”. They learned about the world
through repeatedly watching films on DVD with one brother
explaining that “movies opened up another world”. They spent much
of their time reenacting scenes, using intricately handmade
costumes, from their favourite movies such as Reservoir
Dogs, The Dark Knight and Pulp Fiction. Home
schooled by their mother, the brothers were only allowed out into
the community accompanied by their father a handful of times and
sometimes not even every year. When one of the brothers, at the age
of 15, decides to go outside alone their whole life changes and
their confinement ends. The filmmaker, Moselle, first encountered
them walking down a Manhattan street in 2010 dressed as characters
from Reservoir Dogs sparking a fascination with the
brothers that led to her making the documentary.

The film won 7 awards, including the Sundance
Film Festival Grand Jury Prize 2015 and the Edinburgh International
Film Festival award for Best Documentary Feature Film. More
information is given in an excellent interview by Tom Shone,
published in the Telegraph
newspaper in August 2015.

The Film

The Wolfpack tells the brothers’ story
through a collage of early home movie footage and the interactions
and excursions filmed by Crystal Moselle as their biography is
brought up to date. What is immediately striking is how similar the
brothers look and that, at the wish of their father who was a Hare
Krishna devotee, they all have long flowing hair. It is also
interesting that the Angulo boys seem very appropriate and measured
in their behaviour towards each other, the filmmaker and to their
parents. It seems that Moselle was the first person they had ever
experienced visiting their apartment. The back story of their
parents’ earlier life emerges gradually and the eventual interviews
with their, initially camera shy, father reveal his strong opinions
about his own powers and purpose but also his paranoid view of New
York society. When he moved to America from Peru, it emerges that
he had planned to settle the family in Scandinavia because he
approved of the social support offered in those countries. Their
mother seems to be suffering from her husband’s influence too and
this creates some uncomfortable tensions for the viewer as the
story unfolds.

The film moves into a different section once
fifteen year old Mukunda decides to go out into the community
alone, wearing a mask that had been made for the re-enactment of a
movie scene. Police soon detain him as his visits into various
shops concern the public and he ends up being admitted to a
psychiatric ward for assessment, which he really enjoyed. On
returning back home with regular psychotherapy sessions set up,
Mukunda refuses to be controlled by his father and the brothers’
confinement comes to an end. All of the brothers are offered
psychotherapy. The film then records their first forays into the
community doing the things that many adolescents do, such as going
to the cinema or going to the beach. The scene in which the
brothers experience a swim in the sea for the first time is
extraordinary in that it brilliantly captures the complete novelty
and fear involved in this strange new adventure. One of the
brothers cannot follow the others in to the water and stays on the
sand despite their encouragement and reassurance. Everything is new
and unknown, yet familiar through the films that they have watched
endlessly. Always dressing alike and initially resembling the
characters in the film Reservoir Dogs with suits and
sunglasses on, the brothers acquired the nickname of The Wolfpack.
Perhaps because they live in New York, their eccentricity of
appearance was seen as ‘cool’ rather then ‘strange’ and this has
surely been an important factor in their integration into that
society in recent years. Towards the end of the film some glimpses
are given of one of the brothers as he moves out of the family
apartment and finds a job, although this leaves the viewer hungry
for more information and full of unanswered questions about the
plight of the whole family.

Relevance to the Field of Mental Health

The Wolfpack is a documentary that offers
the opportunity to discuss the safeguarding of children and the
extent to which family life choices can be defined as eccentric or
as emotionally abusive; normal or abnormal. Could this situation
have existed in the UK or in other countries around the world? It
also provides a fantastic framework for a discussion about how
children acquire healthy social and emotional skills growing up and
whether these can in part be met by a large family group of
siblings. Their mother appears as a kind, caring but seemingly
passive presence although her crucial role as their educator was
the source of finance for the whole family. All of the brothers
have since cited her influence, alongside the movies, as critically
important to them in surviving their confinement and in coping with
the difficult relationship with their father. It is interesting
that the brothers chose to watch extremely violent films (and
important to note that many of the films viewed by the young
brothers are rated 18+) and yet they do not immediately appear to
have difficulties with the control or expression of aggression,
although it is perhaps too early to be sure of their ability to
handle conflict outside of the family. They have stated that they
were surprised when they found the world outside their flat is not
quite as they’d seen it in the movies and one of the brothers has
talked about being surprised to see members of the public greeting
each other openly with hugs and kisses.

The Wolfpack is a fascinating documentary
film that draws you in to the intimate experiences of the Angulo
brothers growing up, providing a developmental history and
challenging the viewer to imagine how such an experience might
feel. It leaves you wondering just how the brothers will forge a
life in the world outside in future years and surely begs for a
sequel to be made that can update their extraordinary story.

• More information about The Wolfpack can
be found at IMDB, as can a short
trailer.

•The Wolfpack is available on DVD from
amazon.co.uk or for streaming on Amazon
video.

• Minds on Film is written by Consultant
Psychiatrist, Dr Joyce Almeida

Love & Mercy, directed by Bill Pohlad, was
released in the USA in June 2015. The film is a biopic of the life
of Brian Wilson, the highly creative and talented musical force
behind The Beach Boys, whose mental health deteriorated in the mid
1960s as the group produced their Pet Sounds album. The film uses
two different actors to play Wilson - Paul Dano as the younger man
and John Cusack as the older - allowing the film to span a
significant portion of his life with a clear distinction between
‘before’ and ‘after’ the onset of his mental illness. Love and
Mercy shows the signs and symptoms of his developing mental
illness and also examines the treatment he received from
psychologist Dr Eugene Landy. Of particular interest is that Wilson
was involved in the making of Love and Mercy and when
asked in an interview for Rolling Stone, in June 2015,
(Brian
Wilson’s Better Days by Jason Fine) about how he
felt on seeing the film, responded, “It was hard to watch the first
time," Wilson admits. "I felt exposed. But it's a factual film.
Whatever the film shows, it was much worse in real life."

TheFilm

Love & Mercy opens with the young
Brian Wilson trying to compose some music, talking aloud to himself
as he wonders what would happen if he were to lose that ability.
The film then flashes forward to the older Brian in a car salesroom
wanting to buy a Cadillac from sales assistant Melinda Ledbetter.
They sit in a car together and he writes on a card for her the
words ‘Lonely, Scared, Frightened’, which she only reads when he
has left the showroom. After a short time alone in the car Brian’s
minders join them and Melinda learns the identity of her slightly
strange customer. The film proceeds to cut between scenes from
Brian’s twenties, composing and recording songs with The Beach
Boys, and scenes in his later life when he was under the total
control of therapist Eugene Landy. His increasing attraction to
Melinda, who Landy initially permits him to ‘date’ for a while,
appears to awaken something in him.

In the earlier time frame, Brain’s relationship
with his father is portrayed as very difficult, and several
characters refer to the beatings the father gave all of the
brothers when they were children. His father seems to be struggling
with his own feelings of depression and is locked in a critical,
competitive musical battle with Brian, his most sensitive son.
After Brian suffers a panic attack on a flight home from a concert
he asks to stay at home and compose rather than join the band on
tour. His brothers and cousin reluctantly agree. It is then that
Brian experiences the first symptoms of his psychotic illness, and
soon after that, he attempts to ‘clear his head’ by taking LSD. He
begins to compose songs that are sadder and more complex in their
composition, much to the dismay of his cousin in particular. His
symptoms worsen steadily and are particularly acute in a scene in
the swimming pool at his home where the band are meeting to discuss
their musical direction. Brian’s paranoia is revealed then when he
states that Phil Spector is bugging the house and insists on having
a discussion in the deep end of the pool because he believes that
it is the only safe place to be. Despite this behaviour, which must
be taken in the context of the ‘psychedelic sixties’ in Los
Angeles, only one brother actually expresses real concern about his
mental state at this time, perhaps explaining why alcohol and drugs
initially became the means to self medication, rather than
obtaining formal psychiatric help.

The later life story proceeds with the chilling
depiction of Landy’s total control over Brian’s life, especially as
the relationship with Melinda starts to deepen. She is warned off
by Landy and subsequently resolves to free Brian when he pleads
with her to help him, whilst also revealing to her that he hears
voices. Melinda contacts Brian’s brother Carl, providing him with
some written evidence of the abusive relationship Landy has
developed with Brian, resulting in a successful lawsuit which
prevents Landy from having any contact with Brian. This paves the
way for Brian’s relationship with Melinda to develop romantically.
The film closes with the real Brian Wilson performing the title
track to the film, which he composed, called ‘Love &
Mercy’.

Relevance to the Field of Mental Health

Love & Mercy is a film about living
with mental illness (Brian Wilson was finally diagnosed with
schizoaffective disorder). It is a biography of great relevance to
mental health professionals, as Wilson’s story gives a sense of the
tensions in the relationship with his bullying father, the delayed
diagnosis of his psychosis, his self-medication with illicit drugs
and alcohol, unorthodox treatment with a controlling therapist and
his eventual improvement aided by the support and love of the woman
who uncovers the abuse and eventually becomes his second wife. As
such, the film invites the viewer to consider all of the factors
that may have played a part in the genesis and course of Wilson’s
psychotic disorder. In an interview for ABILITY magazine in 2006, he
discussed in some detail the symptoms of his schizoaffective
illness, including auditory hallucinations, extreme anxiety,
depression and paranoia, which he began to experience at the age of
25. Wilson states that he suffered these symptoms for 15 years
before seeking professional help, using cocaine and heroin in an
attempt to manage them.

The psychologist, Eugene Landy, that Wilson
consulted was pioneering a model of care called ’24 hour therapy’,
which involved taking complete control of the life of the person
concerned. However, this practice fell short of acceptable
professional standards when it included controlling and varying the
administration of the drugs prescribed by Wilson’s psychiatrist,
controlling who Wilson could see at any particular time and in the
ultimate conflict of interests, appointing himself as Wilson’s
business manager and executive producer. Melinda Ledbetter and
Wilson’s family became increasingly concerned by the hold Landy had
on him and they finally took legal steps to end the relationship.
As a result, Landy lost his license to practice Psychology in
California in1989. This aspect of the film has particular relevance
to mental health professionals, as it offers an opportunity to
consider how vulnerable mental illness can make people and how
important it is to safeguard those individuals who may lack the
mental capacity to make important life decisions for themselves at
any particular point in their life. For further information on the
UK policy on safeguarding, visit the UK government website and
search for the policy document entitled Safeguarding policy:
protecting vulnerable adults (available to download from The
Office of Public Guardian).

Now 73, Wilson states that he continues to hear
derogatory voices but battles with them more successfully to block
them out, especially when he is performing. It seems that his
mental state continues to fluctuate but that any depressive
episodes are usually noticed and dealt with quickly with the
support of his wife, Melinda. He takes long-term medication and
believes that his wife and family plays a very important part in
the maintenance of his mental stability such that he is able to
engage actively and successfully in the world of music again.

Additionally, Love & Mercy has a
superb soundtrack, which reproduces many of The Beach Boys’ famous
tracks and portrays the recording processes in fascinating detail.
For anyone interested in understanding Wilson’s particular musical
ability there is an informative blog entitled Was musical memory the secret
to Brian Wilson’s genius?, by Victoria
Williamson, vice chancellor’s fellow for music at the University of
Sheffield, published in The Guardian newspaper in January
2016. In the blog Williamson explores whether Wilson’s musical
talent may be related to the fact that he hears musical phrases
playing constantly in his head. This rare phenomenon becomes even
more interesting when considering that he suffers from persistent
auditory hallucinations of a derogatory nature, which first started
to appear entangled with musical phrases, as depicted in the
film.

This is a powerfully moving film about a life lived
with a psychotic illness that offers any mental health professional
the opportunity to enhance their empathic understanding of how it
feels to suffer from such a condition.

• More information about Love & Mercy
can be found at IMDB,
where a short trailer can be viewed.

• Love & Mercy is available on DVD
from amazon.co.uk or for streaming on Amazon
video.

• Minds on Film is written by Consultant
Psychiatrist, Dr Joyce Almeida